Advanced maternal age (AMA) and 75 g oGTT glucose levels are pedictors for insulin therapy in women with gestational diabetes (GDM)
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Josefine Theresia Koenigbauer
,
Laura Fangmann
Abstract
Objectives
Gestational diabetes (GDM) is a common complication during pregnancy that is strongly associated with adverse fetal and maternal outcomes. Advanced maternal age (≥35 years) is a known risk factor for GDM. Studies advocate that GDM comprises distinctive metabolic entities, suggesting an individualized approach based on early pregnancy characteristics (such as 75 g oGTT values, maternal age, obstetric history).
Methods
The oGTT blood glucose levels of 1,664 women were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated postprandial hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1 h and 2 h values after glucose application. These three subtypes were analysed regarding baseline characteristics as well as fetal and maternal outcome in the context of maternal age.
Results
This analysis reveals that the 75 g oGTT levels and maternal age can distinguish metabolic phenotypes in women with GDM. The overall rate of insulin therapy required was higher in women from the GDM-CH group and increased with maternal age (31.7 %, 38.2 %, <35 years, ≥35–39 years respectively, vs. total insulin rate 22.3 %, p-value <0.001). Women ≥35 years displayed a significantly higher caesarean delivery (CD) rate (<35 years 34.6 %, 38.4 %, 41.1 % vs. ≥35 years 54.8 %, 47.6 %, 46.5 %, GDM-IFH, GDM-IPH, GDM-CH respectively, p-value <0.001).
Conclusions
Women with fasting hyperglycemia, especially those with combined hyperglycemia and advanced maternal age (AMA) display a higher risk for unfavorable perinatal outcome. A categorization based on oGTT values and maternal age, as well as other characteristics can facilitate a basis for clinical risk stratification. Women at risk should receive an individualized and intensified perinatal care as well as interventional therapies.
Acknowledgments
We thank Petra Weid for initiating this analysis and her wonderful and heartwarming work at the Charité Diabetes Clinic for almost two decades. We are thankful to work with all the motivated mothers and families, willing to make a difference for the future of their children.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: Ethical approval was received from the Ethics Committee of Charité University Hospital on February 6th, 2023 (EA2/255/22).
References
1. Group, HSCR, Metzger, BE, Lowe, LP, Dyer, AR, Trimble, ER, Chaovarindr, U, et al.. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002.10.1056/NEJMoa0707943Suche in Google Scholar PubMed
2. Metzger, BE, Gabbe, SG, Persson, B, Buchanan, TA, Catalano, PM, Damm, P, et al.. International Association of D, Pregnancy Study Groups Consensus P. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82. https://doi.org/10.2337/dc09-1848.Suche in Google Scholar PubMed PubMed Central
3. Franzago, M, Fraticelli, F, Stuppia, L, Vitacolonna, E. Nutrigenetics, epigenetics and gestational diabetes: consequences in mother and child. Epigenetics 2019;14:215–35. https://doi.org/10.1080/15592294.2019.1582277.Suche in Google Scholar PubMed PubMed Central
4. Huy, C, Loerbroks, A, Hornemann, A, Rohrig, S, Schneider, S. Prevalence, trend and determining factors of gestational diabetes in Germany. Geburtshilfe Frauenheilkd 2012;72:311–5. https://doi.org/10.1055/s-0031-1298390.Suche in Google Scholar PubMed PubMed Central
5. Helseth, SA, Waschbusch, DA, Gnagy, EM, Onyango, AN, Burrows-MacLean, L, Fabiano, GA, et al.. Effects of behavioral and pharmacological therapies on peer reinforcement of deviancy in children with ADHD-only, ADHD and conduct problems, and controls. J Consult Clin Psychol 2015;83:280–92. https://doi.org/10.1037/a0038505.Suche in Google Scholar PubMed PubMed Central
6. Paulo, MS, Abdo, NM, Bettencourt-Silva, R, Al-Rifai, RH. Gestational diabetes mellitus in Europe: a systematic review and meta-analysis of prevalence studies. Front Endocrinol 2021;12:691033. https://doi.org/10.3389/fendo.2021.691033.Suche in Google Scholar PubMed PubMed Central
7. Reitzle, L, Schmidt, C, Heidemann, C, Icks, A, Kaltheuner, M, Ziese, T, et al.. Gestational diabetes in Germany: development of screening participation and prevalence. J Health Monit 2021;6:3–18. https://doi.org/10.25646/8325.Suche in Google Scholar PubMed PubMed Central
8. (Destatis) SB. Zahl der Woche Nr 18 vom 3. Mai 2022 2022 [05/03/2023]. Available from: https://www.destatis.de/DE/Presse/Pressemitteilungen/Zahl-der-Woche/2022/PD22_18_p002.html#:∼:text=WIESBADEN%20%E2%80%93%20In%20Deutschland%20waren%20im,Mai%20mitteilt Suche in Google Scholar
9. Teede, HJ, Harrison, CL, Teh, WT, Paul, E, Allan, CA. Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for prevention. Aust N Z J Obstet Gynaecol 2011;51:499–504. https://doi.org/10.1111/j.1479-828x.2011.01356.x.Suche in Google Scholar
10. Kalok, A, Peraba, P, Shah, SA, Mahdy, ZA, Jamil, MA, Kampan, N, et al.. Screening for gestational diabetes in low-risk women: effect of maternal age. Horm Mol Biol Clin Invest 2018;34. https://doi.org/10.1515/hmbci-2017-0071.Suche in Google Scholar PubMed
11. Lamminpaa, R, Vehvilainen-Julkunen, K, Gissler, M, Selander, T, Heinonen, S. Pregnancy outcomes in women aged 35 years or older with gestational diabetes – a registry-based study in Finland. J Matern Fetal Neonatal Med 2016;29:55–9. https://doi.org/10.3109/14767058.2014.986450.Suche in Google Scholar PubMed
12. Pinheiro, RL, Areia, AL, Mota Pinto, A, Donato, H. Advanced maternal age: adverse outcomes of pregnancy, A meta-analysis. Acta Med Port 2019;32:219–26. https://doi.org/10.20344/amp.11057.Suche in Google Scholar PubMed
13. Lean, SC, Derricott, H, Jones, RL, Heazell, AEP. Advanced maternal age and adverse pregnancy outcomes: a systematic review and meta-analysis. PLoS One 2017;12:e0186287. https://doi.org/10.1371/journal.pone.0186287.Suche in Google Scholar PubMed PubMed Central
14. Waters, TP, Dyer, AR, Scholtens, DM, Dooley, SL, Herer, E, Lowe, LP, et al.. Maternal and neonatal morbidity for women who would Be added to the diagnosis of GDM using IADPSG criteria: a secondary analysis of the hyperglycemia and adverse pregnancy outcome study. Diabetes Care 2016;39:2204–10. https://doi.org/10.2337/dc16-1194.Suche in Google Scholar PubMed PubMed Central
15. Hillier, TA, Pedula, KL, Ogasawara, KK, Vesco, KK, Oshiro, CES, Lubarsky, SL, et al.. A pragmatic, randomized clinical trial of gestational diabetes screening. N Engl J Med 2021;384:895–904. https://doi.org/10.1056/nejmoa2026028.Suche in Google Scholar
16. Crowther, CA, Hiller, JE, Moss, JR, McPhee, AJ, Jeffries, WS, Robinson, JS, et al.. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–86. https://doi.org/10.1056/nejmoa042973.Suche in Google Scholar
17. Crowther, CA, Samuel, D, McCowan, LME, Edlin, R, Tran, T, McKinlay, CJ, et al.. Lower versus higher glycemic criteria for diagnosis of gestational diabetes. N Engl J Med 2022;387:587–98. https://doi.org/10.1056/nejmoa2204091.Suche in Google Scholar
18. Kuo, CH, Chen, SC, Fang, CT, Nien, FJ, Wu, ET, Lin, SY, et al.. Screening gestational diabetes mellitus: the role of maternal age. PLoS One 2017;12:e0173049. https://doi.org/10.1371/journal.pone.0173049.Suche in Google Scholar PubMed PubMed Central
19. Tai, YY, Lee, CN, Kuo, CH, Lin, MW, Chen, KY, Lin, SY, et al.. Simplifying the screening of gestational diabetes by maternal age plus fasting plasma glucose at first prenatal visit: a prospective cohort study. PLoS One 2020;15:e0237224. https://doi.org/10.1371/journal.pone.0237224.Suche in Google Scholar PubMed PubMed Central
20. Rayanagoudar, G, Hashi, AA, Zamora, J, Khan, KS, Hitman, GA, Thangaratinam, S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia 2016;59:1403–11. https://doi.org/10.1007/s00125-016-3927-2.Suche in Google Scholar PubMed PubMed Central
21. Schafer-Graf, UM, Gembruch, U, Kainer, F, Groten, T, Hummel, S, Hosli, I, et al.. Gestational diabetes mellitus (GDM) – diagnosis, treatment and follow-up. Guideline of the DDG and DGGG (S3 level, AWMF registry number 057/008, February 2018). Geburtshilfe Frauenheilkd 2018;78:1219–31. https://doi.org/10.1055/a-0659-2596.Suche in Google Scholar PubMed PubMed Central
22. Clausen, TD, Mathiesen, ER, Hansen, T, Pedersen, O, Jensen, DM, Lauenborg, J, et al.. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care 2008;31:340–6. https://doi.org/10.2337/dc07-1596.Suche in Google Scholar PubMed
23. Gillman, MW, Oakey, H, Baghurst, PA, Volkmer, RE, Robinson, JS, Crowther, CA. Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care 2010;33:964–8. https://doi.org/10.2337/dc09-1810.Suche in Google Scholar PubMed PubMed Central
24. Kotzaeridi, G, Blatter, J, Eppel, D, Rosicky, I, Linder, T, Geissler, F, et al.. Characteristics of gestational diabetes subtypes classified by oral glucose tolerance test values. Eur J Clin Invest 2021;51:e13628. https://doi.org/10.1111/eci.13628.Suche in Google Scholar PubMed PubMed Central
25. Bogdanet, D, Egan, A, Reddin, C, Kirwan, B, Carmody, L, Dunne, F. Atlantic dip: despite insulin therapy in women with IADPSG diagnosed GDM, desired pregnancy outcomes are still not achieved. What are we missing? Diabetes Res Clin Pract 2018;136:116–23. https://doi.org/10.1016/j.diabres.2017.12.003.Suche in Google Scholar PubMed
26. Meregaglia, M, Dainelli, L, Banks, H, Benedetto, C, Detzel, P, Fattore, G. The short-term economic burden of gestational diabetes mellitus in Italy. BMC Pregnancy Childbirth 2018;18:58. https://doi.org/10.1186/s12884-018-1689-1.Suche in Google Scholar PubMed PubMed Central
27. Kusinski, LC, Murphy, HR, De Lucia Rolfe, E, Rennie, KL, Oude Griep, LM, Hughes, D, et al.. Dietary intervention in pregnant women with gestational diabetes; protocol for the DiGest randomised controlled trial. Nutrients 2020;12:1165. https://doi.org/10.3390/nu12041165.Suche in Google Scholar PubMed PubMed Central
28. Landon, MB, Spong, CY, Thom, E, Carpenter, MW, Ramin, SM, Casey, B, et al.. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339–48. https://doi.org/10.1056/nejmoa0902430.Suche in Google Scholar
29. Dong, Y, Wang, L, Lu, Y, Fu, Z, Du, Y, Wang, L. Factors affecting mode of delivery in women of advanced maternal age. Biosci Trends 2021;15:61–3. https://doi.org/10.5582/bst.2020.03375.Suche in Google Scholar PubMed
30. Jeong, Y, Choo, SP, Yun, J, Kim, EH. Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae. Medicine 2021;100:e27063. https://doi.org/10.1097/md.0000000000027063.Suche in Google Scholar
31. Deng, L, Ning, B, Yang, H. Association between gestational diabetes mellitus and adverse obstetric outcomes among women with advanced maternal age: a retrospective cohort study. Medicine 2022;101:e30588. https://doi.org/10.1097/md.0000000000030588.Suche in Google Scholar PubMed PubMed Central
32. Jang, HC, Cho, NH, Min, YK, Han, IK, Jung, KB, Metzger, BE. Increased macrosomia and perinatal morbidity independent of maternal obesity and advanced age in Korean women with GDM. Diabetes Care 1997;20:1582–8. https://doi.org/10.2337/diacare.20.10.1582.Suche in Google Scholar PubMed
33. Zhang, P, Haymar, T, Al-Sayyed, F, Dygulski, S, Dygulska, B, Devi, A, et al.. Placental pathology associated with maternal age and maternal obesity in singleton pregnancy. J Matern Fetal Neonatal Med 2022;35:9517–26. https://doi.org/10.1080/14767058.2022.2044777.Suche in Google Scholar PubMed
© 2023 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Obituary
- A tribute to Professor Moshe Mazor, M.D.
- Mini Review
- Systematic review of the long-term effects of postnatal corticosteroids
- Opinion Paper
- The proposal of the novel fetal shoulder dystocia graduation: a clinical-based opinion
- Corner of Academy
- Prenatal diagnosis of bilobate placenta: incidence, risk factors and impact on pregnancy outcomes
- Original Articles – Obstetrics
- High mobility group box 1 in women with unexplained recurrent pregnancy loss
- Velamentous cord insertion in monochorionic twin pregnancies: a step forward in screening for twin to twin transfusion syndrome and birthweight discordance?
- Advanced maternal age (AMA) and 75 g oGTT glucose levels are pedictors for insulin therapy in women with gestational diabetes (GDM)
- Perinatal, obstetric and parental risk factors for asthma in the offspring throughout childhood: a longitudinal cohort study
- Increased risk of severe COVID-19 in pregnancy in a multicenter propensity score-matched study
- Comparative clinical and placental pathologic characteristics in pregnancies with and without SARS-CoV-2 infection
- An analysis of factors affecting survival in prenatally diagnosed omphalocele
- The impact of abnormal maternal body mass index during pregnancy on perinatal outcomes: a registry-based study from Qatar
- Original Articles – Fetus
- Embryonic and fetal tiny pericardial fluid collections at less than 12 weeks of gestation
- Modeling fetal cortical development by quantile regression for gestational age and head circumference: a prospective cross sectional study
- The effect of 50 GR oral glucose tolerance test on fetal celiac artery and superior mesenteric artery Doppler parameters in healthy pregnancies
- Original Articles – Neonates
- Carboxyhaemoglobin levels in infants with hypoxic ischaemic encephalopathy
- Exploring professionals’ views regarding prenatal counselling in congenital diaphragmatic hernia
- Letter to the Editor
- Cutting of the strangulated double nuchal umbilical cord in a release of the severe shoulder dystocia: forensically justified or controversial procedure
- Retraction
- Retraction of: Pre-operative tranexemic acid vs. etamsylate in reducing blood loss during elective cesarean section: randomized controlled trial
- Retraction of: Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
Artikel in diesem Heft
- Frontmatter
- Obituary
- A tribute to Professor Moshe Mazor, M.D.
- Mini Review
- Systematic review of the long-term effects of postnatal corticosteroids
- Opinion Paper
- The proposal of the novel fetal shoulder dystocia graduation: a clinical-based opinion
- Corner of Academy
- Prenatal diagnosis of bilobate placenta: incidence, risk factors and impact on pregnancy outcomes
- Original Articles – Obstetrics
- High mobility group box 1 in women with unexplained recurrent pregnancy loss
- Velamentous cord insertion in monochorionic twin pregnancies: a step forward in screening for twin to twin transfusion syndrome and birthweight discordance?
- Advanced maternal age (AMA) and 75 g oGTT glucose levels are pedictors for insulin therapy in women with gestational diabetes (GDM)
- Perinatal, obstetric and parental risk factors for asthma in the offspring throughout childhood: a longitudinal cohort study
- Increased risk of severe COVID-19 in pregnancy in a multicenter propensity score-matched study
- Comparative clinical and placental pathologic characteristics in pregnancies with and without SARS-CoV-2 infection
- An analysis of factors affecting survival in prenatally diagnosed omphalocele
- The impact of abnormal maternal body mass index during pregnancy on perinatal outcomes: a registry-based study from Qatar
- Original Articles – Fetus
- Embryonic and fetal tiny pericardial fluid collections at less than 12 weeks of gestation
- Modeling fetal cortical development by quantile regression for gestational age and head circumference: a prospective cross sectional study
- The effect of 50 GR oral glucose tolerance test on fetal celiac artery and superior mesenteric artery Doppler parameters in healthy pregnancies
- Original Articles – Neonates
- Carboxyhaemoglobin levels in infants with hypoxic ischaemic encephalopathy
- Exploring professionals’ views regarding prenatal counselling in congenital diaphragmatic hernia
- Letter to the Editor
- Cutting of the strangulated double nuchal umbilical cord in a release of the severe shoulder dystocia: forensically justified or controversial procedure
- Retraction
- Retraction of: Pre-operative tranexemic acid vs. etamsylate in reducing blood loss during elective cesarean section: randomized controlled trial
- Retraction of: Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
